The undervaluation of nursing work is centuries long – a very chronic long-term condition (LTC). And, as with all LTCs, there is no quick cure.
It’s worth remembering, as we clamour for a pay equity settlement and complain about the length of time it’s taking, that nursing was born of two misogynist power structures – the military and the church – and has been shaped by those forces.
It’s worth remembering that in the July 1909 editorial of Kai Tiaki, its founder and editor Hester Maclean wrote: “We must… guard against any element of trades unionism creeping in among us. A nurse must be a woman, working, not in the first place for the sake of money making but for the good of her fellow creatures …”
It’s worth remembering the strict social and cultural mores that oppressed women, controlled their fertility, restricted their freedoms and dictated their destinies throughout the last century. Think student nurses corralled into nurses’ homes with strict rules controlling their behaviour and freedoms. Think a nurse having to quit the profession if she chose to get married. Think women doing the same job as men getting paid less and that the Equal Pay Act 1972 only pertained to the public service.
And any government-funded settlement with such major fiscal implications must be scrutinised every step of the way.
And it’s worth remembering that even though nurses make up 68 per cent of the health workforce today, their power within the sector is not commensurate with those numbers for a vast range of reasons related to gender, power and what’s valued in our society.
The current average gender pay gap stands at 10 per cent, rising to 21.5 per cent and 17.9 per cent for Pacific and Māori women respectively.
So against this background, it’s a little unrealistic to think pay equity is going to be achieved in a two-year time frame.
Along with the historical context, there is also the contemporary reality of achieving a robust pay equity deal for professions with a plethora of roles and specialties. And any government-funded settlement with such major fiscal implications must be scrutinised every step of the way. The process is being overseen by the State Services Governance Group and is neither simple nor straightforward.
A pay equity deal, backdated to December 31, 2019, was secured through the 2018 NZNO/district health board multi-employer collective agreement (MECA) negotiations. That meant NZNO did not have to pursue a formal claim for pay equity. Securing the deal was just the first step in a complex, multi-layered process.
Since the journey began, those working on behalf of members have conducted more than 200 interviews with nurses and midwives to gauge the range and responsibilities of all the roles included in the two professions. These interviews were then summarised into “role profiles” – a full description of all that each role entailed. The summaries were then validated.
The next step was identifying male comparator occupations. Approval from both those doing the work and their employers had to be sought, so the men could be interviewed to establish the extent of the range and responsibilities of these occupations. And, as with the nurse and midwife interviews, they had to be summarised into role profiles.
The next phase was to use a pay equity assessment tool to determine whether the nurse/midwifery roles and the male comparator roles were, in fact, comparable. The tool assesses 12 factors in three categories: skills; responsibilities; and conditions and demands of both the nursing/midwifery and male comparator jobs. What is being assessed at this point is whether the work of the comparator is actually comparable to the work of nurses/midwives.
This process is then double-checked, using another pay equity tool. A remuneration expert is now examining the total remuneration both the nurse/midwife roles and the comparator roles receive to assess what the pay gap is and whether it is due to gender.
How to close the gap
Once this work is completed, all involved will know whether nursing and midwifery work has been undervalued and by how much. Then negotiating how that pay gap will be closed can begin.
A multidisciplinary team of NZNO, Public Service Association, Midwifery Employment Relations Advisory Service staff and delegates, and employer representatives, has been involved in this work. Many have had to be released from their day jobs and have had to undergo specialist training to do the work. There is no lack of commitment or determination to achieve pay equity on the part of those involved. But throw in a global pandemic, a two-month national lockdown and regional lockdowns, and it is hardly surprising we are not there yet.
But we will get there. Nurses and midwives will, for the first time in their history, be paid what they are worth. And hopefully that will mean more people will want to become nurses and midwives, enhancing both the quality of care and the quality of their working lives.
So, let’s celebrate the fact we can and will achieve genuine pay equity – remembering good things take time – and let’s give a huge shout out to those who have worked so hard to get it for us.